Representing Patient Clinical Problem List (i.e., "Conditions")

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard for observation values	SNOMED CT® U.S. Edition	Final	Production		Yes	Free	N/A
Standard	ICD-10-CM	Final	Production		No	Free	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
The use of SNOMED CT U.S. Edition for this interoperability need, codes should generally be chosen from three axes: Clinical finding, Situation with explicit context, and Event. SNOMED CT U.S. Edition supports the combination of codes (post-coordination) to generate new meaning. Codes from other axes can be used in post-coordination. The need to pick multiple codes may be seen as a disadvantage. This can be avoided if post-coordination is limited to the backend, exposing a single code for users to pick. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	PHINVADS Problem Value Set 2.16.840.1.113883.3.88.12.3221.7.4 CORE Problem List Subset urn:oid: 2.16.840.1.113762.1.4.1018.240

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

The use of SNOMED CT U.S. Edition for this interoperability need, codes should generally be chosen from three axes: Clinical finding, Situation with explicit context, and Event.
SNOMED CT U.S. Edition supports the combination of codes (post-coordination) to generate new meaning. Codes from other axes can be used in post-coordination. The need to pick multiple codes may be seen as a disadvantage. This can be avoided if post-coordination is limited to the backend, exposing a single code for users to pick.
For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

Comment

Submitted by pwilson@ncpdp.org on 2020-11-07

NCPDP Comment

Request ONC add ICD-10 as a value. In NCPDP SCRIPT Standard Version 2017071 when clinical problems are reported, ICD-10 is required and SNOMED CT® is optional.
Add the following:

Type-Implementation Specification

Standard Implementation/Specification- ICD-10

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 4

Federally Required – Yes

Cost – $

Test Tool Availability – Yes

Include Test Tool Link: https://tools.ncpdp.org/erx/#/home

Submitted by gldickinson on 2020-10-23

Preserving Clinical Context

General Comments:

USCDI specifies lots of clinical data classes and data elements

Resolving to myriad de-coupled fragments
With vanishingly little focus on:
- Clinical context and vital inter-relationships, e.g., between problems, diagnoses, complaints, symptoms, encounters, history and physical findings, allergies, medications, vaccinations, assessments, goals/objectives, clinical decisions, orders, results, diagnostic procedures, interventions, observations, treatments/therapies, referrals, consults, outcomes, protocols, care plans and status...
- Elements and context + purpose of capture: e.g., blood pressure, its measurement (systolic, diastolic), its unit of measure (mm/Hg), its reason for capture, its context of capture (sampling site, sampling method, patient position, at rest/during/post exercise...

It is crucial to consider, determine and resolve how clinical content and context are bound together and preserved in USCDI. The ultimate end user (often a clinician) must be able to readily discern context and inter-relationships – otherwise USCDI places an undue (and often unresolvable) burden on this user. Only the source EHR/HIT system can structure clinical content and context properly. Once data is stuffed into the USCDI framework and related exchange artifact (e.g., FHIR resources) this opportunity is forever lost.

Submitted by mcpatric on 2017-11-20

Post-coordination

The 2nd and 3rd bullets both describe post-coordination and could be combined into one.
'left leg fracture' now has a single SNOMED CT code; ‘left kidney stone’ could be used instead as an example of post-coordination.

Submitted by kwboone on 2017-11-20

Agree with Rob McClure,…

Agree with Rob McClure, LOINC does NOT seem appropriate in this context.

Submitted by rmcclure on 2017-10-04

Use of LOINC needs more explanation

Not sure how LOINC would be used. You should explain how that code system is appropriate here.